Gettysburg Medical News
 The Clinical View
 by P.E. Hoffsten, M.D.
 29 March 2006

HOW LONG WILL YOU LIVE?

            The gentleman was 90 years old.  He was living in a large assisted living facility where one meal a day was provided in a central dining room.  This provided both nutritional support and companionship for this gentleman whose wife had passed away years before.  He had no major medical illnesses having recovered from prostate cancer 20 years before.  But he did have macular degeneration which was impairing his vision.  He said that he was having an increasing difficulty hearing.  Trying to communicate with him during our visit, this was certainly evident.  He had never bothered to get a hearing aid.  He had lost 11 pounds in the last year and indeed it was 11 pounds that he could well afford to lose.  But what was alarming was that he wasn’t trying to lose weight.  His mind was sharp and he enjoyed visiting with friends or listening to the news on television or radio; but he could no longer read.  He said that walking to the dining room was good exercise but it was taking longer and now he was using a cane for stability.

            As I mentioned, he had a very sharp mind and specific questions at this time.  First, he said that hearing aids were very expensive and he wondered if he should obtain a hearing aid.

Second, he wondered if he needed a more supportive environment than was provided by his present assisted living situation.  He noted that this would mean up giving up many of  the possessions which he held dear and moving into a much smaller living quarter.  He said that he wasn’t really ready to do that.  He wondered how long he was going live and would hearing aids be worth getting.  This proud man asked these questions with rational consideration but grace that had me holding back tears.

            But as one does at a time like that, we made a joke and laughed and I got down to the business of answering his questions.  I told him first that with his health profile at 90 years of age, statistics showed that he had a 50% chance of living three more years and a 25 % chance of living six more years.  He was surprised at these numbers and made another joke about not being really sure that he wanted that much time.  Then after discussion, I advised him strongly to get hearing aids in order to maintain communication.  Unfortunately, there is very little we could do about macular degeneration to help him read but improving his hearing would be a definite help and well worth the expense.  He still wanted to think about whether to move into a more supportive facility or maintain living where he was.  I suggested to him that familiarity with his present environment was a valuable asset and to consider long and hard before making a move.

            I frequently have patients ask me the question “How long will I live?”  Assuming that the person has no major medical illness at a given age, the expectations are as below:

            For women, age 70-80, one can add three years to the expectations for men.  For women 80 years of ages and older, the numbers are remarkably similar to the values for men.

            These numbers involve the general public.  But certain characteristics will knock a person out of that long lived group into a much shorter life group.  Smoking cigarettes is the most deleterious bad habit our society has.  Over 90% of woman who never smoke and reach age 40 will reach age 70. Pack-a-day women smokers reduce that likelihood of reaching age 70 to only 70%.  For non smoking 40 year old men, there is an 88% chance of reaching age 70.  But if a man smokes at age 40 and continues this, there is only a 50% chance of reaching age 70.  I have been chastised before for harping on the cigarette problem.  I give up.  Trying to talk someone out of smoking is rather like trying to teach a bull how to sing; it does not work and it aggravates the bull.

            Other things that make a difference include attitude.  That line about, “Accentuate the positive, eliminate the negative” has survival value.  For men age 65 to 85, 80% of those with an optimistic attitude live another 15 years.  For those men with a low optimism level, only 50% live another 15 years.  That adage about attitude being important translates into an extra 30 out of 100 men living 15 more years.

            There are so many other factors involved that I can’t enumerate them all here.  But these columns are devoted primarily to preventive medicine which is cheaper and much more effective than taking care of a heart attack at the time it occurs.  Annual checkups to catch disease early, keeping blood pressure down, keeping cholesterol down, avoiding overweight, avoiding risky behavior and getting enough exercise all put an individual into that longer living group.  Those things not only put you into the longer living group but they make you happy to be there and still able to think, walk, and remain continent.  The healthcare professionals at your local clinics don’t do heart surgery, and can’t fix a stroke once it has happened.  But they can help you never need heart surgery and never have the stroke.